ANA-Maine Journal - February 2015

Page 4 ANA Maine Journal February, March, April 2015
ANA News
Consensus Model for APRN Regulation: Licensure,
Accreditation, Certification, and Education
As underscored by the inclusion of APRNs in
recent health system reform efforts, there is increased
appreciation of the important role that APRNs can play
in improving access to high quality cost-effective care.
However, a proliferation of nursing specializations,
debates on appropriate credentials and scope of practice
and a lack of uniformity in state regulations, have limited
the ability of patients to access APRN care.
The document Consensus Model for APRN Regulation:
Licensure, Accreditation, Certification, and Education,
which was completed in July 2008 and endorsed by 44
organizations, 1 delineates the model for future regulation
of advanced practice registered nurses (APRNs). The
Consensus Model, when implemented, will standardize
each aspect of the regulatory process for APRNs, resulting
in increased mobility for APRNs and increased access to
APRN care.
The document was completed through the collaborative
work of the APRN Consensus Workgroup and National
Council of State Boards of Nursing 2 APRN Advisory
Committee, with extensive input from a much larger
APRN stakeholder community. ANA is committed to
work with our constituents, the nursing community, and
the broad stakeholder community to achieve the successful
and timely implementation of the Consensus Model.
This issue brief provides an overview of the Consensus
Model, information about ANA’s work regarding it, and
additional resources.
COMPONENTS OF THE CONSENSUS MODEL
FOR APRN REGULATION
Definition of an APRN
The Consensus Model document provides a detailed
definition of an APRN. Briefly, an APRN is a nurse:
1. Who has completed a graduate-level education
program in preparation for one of the four APRN
roles;
2. Who has passed a national certification examination
and maintains certification;
3. Who has acquired advanced clinical knowledge and
skills;
4. Whose practice builds on the competencies of
registered nurses (RNs) by demonstrating greater
knowledge, increased complexity of skills and
interventions, and greater role autonomy;
5. Who is prepared to assume responsibility
and accountability for health promotion and/
or maintenance as well as the assessment,
diagnosis, and management of patient problems,
including prescription of pharmacologic and nonpharmacologic
interventions;
6. Who has sufficient clinical experience to reflect the
intended license; and
7. Who has obtained a license to practice as an APRN
in one of the four APRN roles
Four APRN roles and population foci
There are four APRN roles defined in the Consensus
Model document:
1. Certified registered nurse anesthetist (CRNA)
2. Certified nurse-midwife (CNM)
3. Clinical nurse specialist (CNS)
4. Certified nurse practitioner (CNP)
APRNs are educated in one of these four roles and in at
least one of six population foci depicted in the diagram of
the APRN regulatory model below.
Individuals will be licensed as independent
practitioners for practice at the level of one of the four
APRN roles within at least one of the six identified
population foci. Education, certification, and licensure
of an individual must be congruent in terms of role and
population foci.
LACE: The four essential elements of APRN regulation
APRN regulation includes four essential elements:
licensure, accreditation, certification, education (LACE):
1. Licensure is the granting of authority to practice.
2. Accreditation is the formal review and approval
by a recognized agency of educational degree or
certification programs in nursing or nursing-related
programs.
3. Certification is the formal recognition of the
knowledge, skills, and experience demonstrated by
the achievement of standards that are identified by
the profession.
4. Education is the formal preparation of APRNs in
graduate degree-granting or post-graduate certificate
programs.
APRN education
The Consensus Model document spells out
requirements 3 for broad-based APRN education, including:
• Formal education with a graduate degree or postgraduate
certificate awarded by an academic
institution and accredited by a nursing or nursing-
Consensus Model continued on page 5
APRN REGULATORY MODEL
APRN SPECIALTIES
Focus of practice beyond role and population focus linked to health care needs
Examples include but are not limited to: Oncology, Older Adults, Orthopedics, Nephrology, Palliative Care
POPULATION FOCI
Licensure occurs at Levels of
Role & Population Foci
Family/Individual
Across Lifespan
Adult-
Gerontology*
Nurse - Anesthetist
Neonatal
Nurse - Midwife
APRN ROLES
Pediatrics
Clinical Nurse
Specialist**
Women’s Health/
Gender - Related
Nurse Practitioner*
Psychiatric-
Mental Health**
+ The certified nurse practitioner (CNP) is prepared with the acute care CNP competencies and/or the primary care CNP competencies. At this point in time the acute care and
primary care CNP delineation applies only to the pediatric and adult-gerontology CNP population foci. Scope of practice of the primary care or acute care CNP is not setting
specific but is based on patient care needs. Programs may prepare individuals across both the primary care and acute care CNP competencies. If Diagram 1: programs prepare
graduates across both sets of roles, the graduate must be prepared with the consensus-based competencies for both roles and must successfully obtain certification in both the acute
and the primary care CNP roles. CNP certification in the acute care or primary care roles must match the educational preparation for CNPs in these roles.